Atrial Fibrillation
AF is the most common sustained arrhythmia seen in clinical practice with an overall prevalence of 700–750 per 100,000 of the population in North America (Chugh et al. Circulation 129:837–47, 2014). As well as resulting in considerable adverse sequelae an
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Atrial Fibrillation Benedict M. Glover and Pedro Brugada
Abstract AF is the most common sustained arrhythmia seen in clinical practice with an overall prevalence of 700–750 per 100,000 of the population in North America (Chugh et al. Circulation 129:837–47, 2014). As well as resulting in considerable adverse sequelae and an increase in hospitalizations there is a 5 fold increase in the risk of stroke associated with non-valvular AF (Wolf et al. Stroke 22:983–8, 1991) and by a factor of 17 in the presence of significant valvular heart disease (Fuster et al. Circulation 123:e269–367, 2011). The risk of AF increases markedly with older age affecting approximately 5 % of people over 65 years and 10 % of people age over 80 years (Miyasaka et al. Circulation 114:119–25, 2006).
Classification of AF AF is classified as paroxysmal, persistent, longstanding persistent or permanent. Paroxysmal AF is defined as two or more episodes of AF each of which terminate within seven days and commonly within 24 h. Persistent AF is sustained generally for greater than seven days (or less if a cardioversion was performed in this time) and requires chemical or electrical cardioversion for termination of the arrhythmia. Longstanding persistent refers to cases in which AF has been present for more than 1 year and previously may have been designated as being permanent; however, an electrical cardioversion or ablation strategy is being
B.M. Glover (*) Department of Cardiac Electrophysiology, Queens University, Kingston, ON, Canada e-mail: [email protected] P. Brugada, MD, PhD Chairman, Cardiovascular Division, Free University of Brussels UZ Brussel-VUB, Brussels, Belgium GVM Group, Cotignola, Italy CEO Medisch Centrum Prof. Dr. P. Brugada, Aalst, Belgium Clinical Electrophysiology Program, Hospiten Estepona, Marbella, Spain © Springer International Publishing Switzerland 2016 B.M. Glover, P. Brugada (eds.), Clinical Handbook of Cardiac Electrophysiology, DOI 10.1007/978-3-319-40818-7_8
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B.M. Glover and P. Brugada
190 Cardiovascular
Hypertension CAD Valvular HD
Metabolic
Thyroid dysfunction DM Obesity
Other Arrhythmias SVT Atrial flutter
AF
Acute Reversible Post operative Infection Pericarditis Myocarditis PE OSA Autonomic Brugada Syndrome Excessive Alcohol
Fig. 8.1 Causes of Atrial Fibrillation. These can be divided into cardiovascular such as hypertension, coronary artery disease (CAD) and valvular heart disease (HD), metabolic, such as thyroid dysfunction, diabetes mellitus (DM) and obesity other arrhythmias such as SVT and atrial flutter and acute reversible causes such as post operative, infections, pericarditis, myocarditis and pulmonary embolism (PE). Other causes include OSA, autonomic, Brugada and excess alcohol
pursued and therefore sinus rhythm may be achieved. Permanent AF also continues for more than seven days and cannot be terminated anymore thus a rhythm control strategy has been unsuccessful or not appropriate.
Etiology The incidence of AF is increased by other cardiovascular and metabolic conditions as
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